Following
is a list of Bone Grafting Procedures offered by us:

Bone
grafting is the replacement of supporting bone around the
teeth which has been lost. It is also known as bone augmentation
or ridge augmentation.

Today, bone
grafting procedures have become almost an integral part
of implant reconstruction. In many instances, a potential implant
site in the upper or lower jaw does not offer enough bone volume
or quantity to accommodate a Rootform Implant of proper size or
in the proper place. This is usually a result of bone resorption
that has taken place since one or more teeth (if not all) were lost.
Bone Grafting procedures usually try to re-establish bone dimension,
which was lost due to resorption.

Although your
surgeon often knows in advance when a graft will be necessary, at
times this is only discovered when the implant site is opened during
surgery and he is prepared to replace the necessary bone.

Sinus
Lift

Sinus
is the term given to anatomical cavities that exist within our body.There
is one in the region of the cheek bone that is termed the Maxillary Sinus.

Our upper teeth especially
the back ones often have their roots dipping into or in close proximity
to the maxillary sinus. The natural response to tooth loss is a shrinkage
in the amount of bone existing around the tooth that was, this means that
if an upper tooth is lost there is a decrease in the height of bone beneath
the sinus. In such a situation if the patient wants Implants it becomes
impossible to insert the implant in such a diminished height of bone,
thereby necessitating such a procedure that would restore the bone height.

This procedure is what we term
as a sinus-lift. It is a very specialized procedure carried out under
strict asepsis. Implants may be inserted at the same stage or at a later
date depending on the situation.

Situations that might necessitate
that a sinus lift be performed before a tooth implant can be placed.

There can be several reasons
why the amount of bone found in the patient's upper jawbone might be insufficient
to accommodate a dental implant. Some of them include:

The
patient's normal jaw anatomy presents complications.

The relative size and shape
of an individual's upper jaw as well as the current size and shape of
their maxillary sinus (the size of the sinus can change with age) varies
among people. While over simplified, any one person may have a combinationof
a relatively small upper jaw and relatively large sinus which together
create a situation where there is an insufficient amount of bone for
the placement of a tooth implant.

The
patient has experienced bone loss due to gum disease.

In situations where advance
periodontal disease (gum disease) is present, the bone that surrounds
and supports the person's teeth is damaged. In the most severe cases,
significant amounts of bone can be lost from around the person's teeth,
to the point where there is no longer an adequate amount of bone in
which to place a tooth implant.

Bone
resorption associated with previous tooth extractions.

When teeth are extracted
the bone that originally held the teeth in place will under go a process
called resorption. The neteffect of this process is that much of the
bone in the region originally occupied by the tooth is lost, possibly
to the point where there is an insufficient amount of bone in which
to place a dental implant.

The magnitude of post
tooth extraction bone loss can be as much as 40 to 60 percent within
the first three years after teeth have been removed. Beyond that
point, the rate of bone loss typically subsides substantially. The
cause of post extraction bone resorption is typically attributed
to disuse atrophy, decreased blood supply, localized inflammation
and/or unfavorable pressure from a dental appliance (denture or
partial denture).

Bone
loss due to other factors.

In some cases a bone deficiency
may be associated with a previous surgical procedure such as a difficult
tooth extraction or the removal of a cyst or tumor.

Dental
implants have gained popularity for treating edentulism,
but some patients develop jaw atrophy, which leaves insufficient bone
for implants. To treat these patients, the sinus lift procedure, which
augments bone, was developed. Altered anatomy from this procedure has
an unusual radiographic appearance, confusing those unfamiliar with it.
We describe the sinus lift procedure and its radiographic appearance.

Block
Bone Grafting

In severe cases the ridge has been reabsorbed and a bone graft is placed
to increase the ridge height and/or width. In these situations, the graft
is taken from another area inside your mouth or body. This dental implant
bone grafting technique is where a block of bone is cut out of one area
and screwed into the area where the dental implants will be placed. Normally,
the block bone graft is placed and allowed to integrate into the jaw bone
for four to six months before the dental implant is placed.

This office procedure is usually performed using general anesthesia and
takes about an hour.

These procedures may be performed separately or together, depending upon
the individual's condition. There are several areas of the body which
are suitable for attaining bone grafts. In the maxillofacial region, bone
grafts can be taken from inside the mouth, in the area of the chin or
third molar region or in the upper jaw behind the last tooth. In more
extensive situations, a greater quantity of bone can be attained from
the hip or the outer aspect of the tibia at the knee.

These surgeries are performed in the out-office surgical suite under IV
sedation or general anesthesia. After discharge, bed rest is recommended
for one day and limited physical activity for one week.

Bone
Expansion

In severe cases, the ridge
has been reabsorbed and a bone graft is placed to increase ridge height
and/or width. This is a technique used to restore the lost bone dimension
when the jaw ridge gets too thin to place conventional dental implants.
In this procedure, the bony ridge of the jaw is literally expanded by
mechanical means. Bone graft material can be placed and matured for a
few months before placing the dental implant.

Nerve-repositioning

The inferior alveolar nerve,
which gives feeling to the lower lip and chin, may need to be moved in
order to make room for placement of dental implants to the lower jaw.
This procedure is limited to the lower jaw and indicated when teeth are
missing in the area of the two back molars and/or and 2nd premolar, with
the above-mentioned secondary condition. Since this procedure is considered
a very aggressive approach (there is almost always some postoperative
numbness of the lower lip and jaw area, which dissipates only very slowly,
if ever), usually other, less aggressive options are considered first
(placement of blade implants, etc.)

Typically, we remove an outer
section of the cheek side of the lower jawbone in order to expose the
nerve and vessel canal. Then we isolate the nerve and vessel bundle in
that area, and slightly pull it out to the side. At the same time, we
will place the implants. Then the bundle is released and placed back over
the implants. The surgical access is refilled with bone graft material
of the surgeon’s choice and the area is closed.

These procedures may be performed
separately or together, depending upon the individual's condition. As
stated earlier, there are several areas of the body that are suitable
for attaining bone grafts. In the maxillofacial region, bone grafts can
be taken from inside the mouth, in the area of the chin or third molar
region or in the upper jaw behind the last tooth. In more extensive situations,
a greater quantity of bone can be attained from the hip or the outer aspect
of the tibia at the knee. When we use the patient’s own bone for
repairs, we generally get the best results.

In many cases, we can use allograft
material to implement bone grafting for dental implants. This bone is
prepared from cadavers and used to promote the patients own bone to grow
into the repair site. It is quite effective and very safe. Synthetic materials
can also be used to stimulate bone formation. We even use factors from
your own blood to accelerate and promote bone formation in graft areas.

Guided Tissue
Regeneration

Soft tissue, such as gum tissue,
grows very fast while bone grows very slow. When a surgical hole is created
by a surgeon, soft tissue grows into the surgical hole very quickly and
blocks out bone from growing into the hole. When bone is needed in an
area to place dental implants, uncontrolled gum tissue growth is a problem.
A membrane barrier can be used to cover the surgical hole and block out
the gum tissue from growing into the area. This allows the more slowly
growing bone to fill the surgical hole without any competition.

The membrane barrier guides the gum tissue away from the surgical defect.
Gums and bone are both tissues and both are guided by the artful placement
of a membrane barrier. Because the bone regenerates in the surgical hole,
the technique is called guided tissue regeneration. Some surgeons call
it guided bone regeneration because implant surgeons are very concerned
about the supporting bone around their dental implants.

Guided tissue regeneration can be used to repair defects around previously
placed dental implants or to create additional bone in deficient areas
before placing dental implants. The surgical hole can be filled with several
different types of materials before covering the area with a protective
membrane barrier.

Ridge
Modification

Deformities in the upper or
lower jaw can leave you with inadequate bone in which to place dental
implants. This defect may have been caused by periodontal disease, wearing
dentures, developmental defects, injury or trauma. Not only does this
deformity cause problems in placing the implant, it can also cause an
unattractive indentation in the jaw line near the missing teeth that may
be difficult to clean and maintain.

To correct the problem, the
gum is lifted away from the ridge to expose the bony defect. The defect
is then filled with bone or bone substitute to build up the ridge. Your
periodontist can tell you about your options for graft materials, which
can help to regenerate lost bone and tissue.

Finally, the incision is closed
and healing is allowed to take place. Depending on your individual needs,
the bone usually will be allowed to develop for about four to 12 months
before implants can be placed. In some cases, the implant can be placed
at the same time the ridge is modified.

Ridge modification has been
shown to greatly improve appearance and increase your chances for successful
implants that can last for years to come. Ridge modification can enhance
your restorative success both esthetically and functionally.

Types of Bone
Grafting Materials

With respect to the Bone Graft
material used, we have to differentiate between several choices. All materials
can be categorized into five different categories:

Autograft
or autogenous bone graft

Allograft
or allogenic bone graft

Xenograft
or xenogenic bone graft

Alloplast
or alloplastic bone graft

Growth Factors

Each of the bone graft materials
is usually developed with a specific purpose or advantage in mind. Your
surgeon will make a decision with respect to the bonegraft material, based
on your individual needs and the latest research in that field.

Healing Period After
Bone Grafting

The healing period required
after a bone graft ranges between three and nine months, depending on
the individual case. The implant can be placed once the graft is completely
healed. In some cases, implant placement and bone grafting can be done
at the same time.

BONE GRAFTING
FAQ

What is Grafting?

Grafting is a procedure used
to replace / restore missing bone or gum tissue.

Gum Grafting:

A gum (gingival) graft is used
to replace missing and / or receded gum tissue.

Types of gum tissue:

There are two types of gum
tissue in the mouth, one of which surrounds the necks of the teeth and
is thick and protective in nature (keratinized gingiva). The other of
which lines our cheeks and floor of the mouth whose purpose is to be elastic
and mobile in nature (mucosa).

Why is a gum graft
needed?

Soft tissue grafts are used
to replace missing thick tissue (keratinized gingiva), which has worn
away from the necks of the teeth for a variety of reasons. The purpose
of gum grafting is to minimize and/or arrest the progression of recession.

Unfortunately associated with
every type of recession, there is bone loss, because the bone resides
just beneath the gums. Therefore, if the gums have receded, then the bone
too has receded. The purpose of gum grafting is to arrest the progression
of recession and thereby halt the bone loss as well, by restoring a thick
zone of protective tissue around the neck of the tooth / teeth which exhibits
an absence of this thick keratinized gum tissue.

In certain instances it is
not only possible to restore the missing keratinized (thick / protective)
gum tissue, but also to cover the exposed root surface of the tooth /
teeth in question. Other issues must be addressed as well, such as the
biting forces being placed on the teeth.

Unbalanced forces placed on
the teeth in the presence of clenching or grinding can predispose an individual
to recession. Being a candidate for this root coverage procedure, which
is achieved by a connective tissue graft, is to be determined by the individual
practitioner.

Cosmetic Gum Grafts: Esthetic gum grafting can be used to "plump up" the
gum tissue in an area that is deficient and would result an unaesthetic
cosmetic make-over. Remember the teeth and gums should exhibit symmetry,
yet sometimes one side is deficient, therefore, gum grafting may be essential
to achieve symmetry prior to a cosmetic make-over.

What causes recession?

Aggressive brushing - potentially?
Some people believe that aggressive brushing with a hard bristled brush
may be a co-factor in recession or erosion of the neck of the tooth

Excessive biting forces
- clenching and/or grinding? This can result in bending / flexing of
teeth, which will often result in fracture of a small portion of tooth
structure at the gum line (abfractions) and consequently bone and gum
recession

Maloccluded and misaligned
teeth? Teeth that positioned outside the normal arch form of the jaw
are subject to having abnormal forces placed on them causing recession

When treating recession by
gum grafting, the causative factor must also be addressed in order for
the grafting procedure to be successful.

What are the different
types of Gum Grafts?

1. Soft tissue graft: There
are many types of soft tissue grafts. This type of graft involves taking
a small piece of tissue from the surface skin on the roof of the mouth
and transplanting it to areas in the mouth that are lacking. This type
of graft restores and augments the missing thick keratinized gingiva,
but does not result in covering of the exposed root.

2. Connective Tissue Graft:
In this procedure tissue is taken from the undersurface of the palatal
tissue (roof of the mouth) via tiny incisions, and is used to not only
restore missing thick keratinized gum tissue, but also used to cover exposed
roots of the teeth.

What are the types
of bone graft?

1. autogenous - bone taken
from one area of the patient and transplanted to another area requiring
such grafting
2. allograft - either synthetic bone or bone from a bone bank (cadaver
bone)
3. xenograft - bovine /cow bone

Which graft is used
and when and why? Autogenous bone is the "gold standard" and oftentimes
has the most predictable results. This is described as the best type of
graft because such bone is live bone with live active cellular elements
that enhance bone growth, whereas other types of grafts are devoid of
any active cellular material.

Allografts and Xenografts both
do not require a second surgical site as does the autogenous bone. Ample
amounts can be easily obtained.

Barrier membranes In conjunction with bone grafting, membranes are often used
to help stabilize the bone graft as well as displace the gum tissue from
invading the healing bone graft. Gum tissue grows at a much faster rate
than bone, therefore, membranes are used to prevent gum tissue from growing
in and displacing the bone graft before it matures.

How is the sinus lift procedure
performed?

The sinus lift is a surgical
procedure. The specific technique that the dentist utilizes can vary depending
upon their training and experiences but traditionally the procedure has
been performed as follows:

The dentist will make an
incision in the patient's gum tissue on the cheek side of their upper
jaw in the area where the placement of the dental implant is planned
(in the region originally occupied by the patient's bicuspid or molar
teeth). This incision allows the dentist to flap back the patient's
gum tissue and expose the jawbone that lies underneath.

The exposed bone is cut
in a fashion where a "trap door" of bone, hinged at the top, is created.
This movable section of bone is then pushed gently inward and upward
into the sinus cavity. This bone movement caries the sinus membrane
attached to it with it, thus "lifting" the membrane (and hence the sinus
floor) to a new, higher level. The empty space underneath the lifted
sinus membrane is then packed with bone-graft material thus providing
the new bone into which the tooth implant will be placed.

Once the bone-graft material
has been positioned the gum tissue is stitched closed.

In some instances it can
be possible that the dentist will place the dental implant at the same
time that the sinus lift is performed. In most cases, however, a dentist
will allow a healing period of six to nine months before the dental
implant is placed. The specific time frame allowed for healing is dependent
upon the type of bone-graft material that has been utilized

What types of bone-graft materials
are used with the sinus lift procedure?

Several different types of
bone-graft materials can be utilized with the sinus lift procedure. In
some instances the patient's own bone will be used, such as bone harvested
from another location in the patient's mouth or else from other bones
(including the hip (iliac crest) or shin bone (tibia)). In other instances
prepared bone (frozen bone, freeze-dried bone, demineralized freeze-dried
bone), either human or from another species (i.e. bovine), can be purchased
from a tissue bank for use. Another alternative involves the use of synthetically
derived graft material such as hydroxyapatite.

The procedure involves placement
of a bone graft that may be obtained from the patients body or may be
synthetic bone substitutes.The surgery lasts around 1-2 hours & may
be carried out under Local / General anesthesia. Normal activity may be
resumed from the third day onwards.

The entire procedure is carried
out from inside the mouth & there is no visible scar on the face,
nor does it alter the facial topography in any way.There are generally
no attending post-operative complications if all the given instructions
are followed.